Pub Date : 2020-01-27DOI: 10.17511/IJOSO.2020.I01.04
Abhishek Kumar, S. Snehlata
Objective: To determine the presentation, anatomical distribution, diagnostic method, management and outcome of hollow viscus injury (HVI) from blunt abdominal trauma. Methods: This was a retrospective cross-sectional study including patients with blunt abdominal trauma leading to HVI admitted at Vandana Nursing Home and IVF Clinic, Hazaribag. A prospective comparison study over a period of 6 years (April 2012 to May 2018). Data were retrieved from patients’ medical records. Total 43 patients with HVI due to blunt abdominal trauma, who underwent laparotomy at our institute, were reviewed. Data regarding clinical presentation, anatomical distribution, management and outcome were recorded and analysed. Results: Out of 43 patients 87.1% were men and 12.9% were women. Mean age of patients was 29±14.02 years. The most common site of injury was ileum (46.2%) followed by jejunum (44.5%). There were 2 gastric perforations (4.6%), 1 (2.3%) duodenal, 1 (2.3%) colonic, 1 (2.3%) sigmoidal and 1 (2.3%) rectal injuries. One caecal injuries was also recorded. Road traffic accident was the most common mechanism of injury (57.2%) followed by fall from height (36.4%) and assault (6.4%). Free gas under diaphragm on erect abdomen radiography was seen in 85.5% of cases while preoperative CT Abdomen was done in 11.6% of cases. Treatment consisted of simple closure of the perforation (66.5%), resection and anastomosis (11.0%) and stoma (22.5%). Major complication was anastamotic leak which was recorded in 6.4% cases and 15.6% patients developed burst abdomen. Average hospital stay was 13±6 days. Overall mortality rate was 12.7%. Conclusion: Although early recognition of intestinal injuries from blunt abdominal trauma may be difficult in all cases, it is very important due to its tremendous life-threatening potential. Age of the patient, anatomical site and time of presentation are probably main prognostic factors
{"title":"A characteristic of hollow viscus injury (HVI) following blunt abdominal trauma: a study done in Vandana Nursing Home and IVF Clinic, Hazaribag, Jharkhand, India","authors":"Abhishek Kumar, S. Snehlata","doi":"10.17511/IJOSO.2020.I01.04","DOIUrl":"https://doi.org/10.17511/IJOSO.2020.I01.04","url":null,"abstract":"Objective: To determine the presentation, anatomical distribution, diagnostic method, management and outcome of hollow viscus injury (HVI) from blunt abdominal trauma. \u0000Methods: This was a retrospective cross-sectional study including patients with blunt abdominal trauma leading to HVI admitted at Vandana Nursing Home and IVF Clinic, Hazaribag. A prospective comparison study over a period of 6 years (April 2012 to May 2018). Data were retrieved from patients’ medical records. Total 43 patients with HVI due to blunt abdominal trauma, who underwent laparotomy at our institute, were reviewed. Data regarding clinical presentation, anatomical distribution, management and outcome were recorded and analysed. \u0000Results: Out of 43 patients 87.1% were men and 12.9% were women. Mean age of patients was 29±14.02 years. The most common site of injury was ileum (46.2%) followed by jejunum (44.5%). There were 2 gastric perforations (4.6%), 1 (2.3%) duodenal, 1 (2.3%) colonic, 1 (2.3%) sigmoidal and 1 (2.3%) rectal injuries. One caecal injuries was also recorded. Road traffic accident was the most common mechanism of injury (57.2%) followed by fall from height (36.4%) and assault (6.4%). Free gas under diaphragm on erect abdomen radiography was seen in 85.5% of cases while preoperative CT Abdomen was done in 11.6% of cases. Treatment consisted of simple closure of the perforation (66.5%), resection and anastomosis (11.0%) and stoma (22.5%). Major complication was anastamotic leak which was recorded in 6.4% cases and 15.6% patients developed burst abdomen. Average hospital stay was 13±6 days. Overall mortality rate was 12.7%. \u0000Conclusion: Although early recognition of intestinal injuries from blunt abdominal trauma may be difficult in all cases, it is very important due to its tremendous life-threatening potential. Age of the patient, anatomical site and time of presentation are probably main prognostic factors","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125420981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-24DOI: 10.17511/ijoso.2020.i01.02
Abhishek Kumar, S. Snehlata, M. Srivastava, R. S. Vandana
Background: Use of diagnostic and therapeutic laparoscopy in infertility has been a focus of attention in recent years and demonstrated to be very effective method in evaluating these cases. The main objective of the study was to detect the diagnostic efficacy of laparoscopy in uterine, pelvic and ovarian pathologies. Methods: This study was conducted from April 2017 to August2019.This prospective study included 50 infertile women and it was conducted at Vandana nursing home and IVF clinic. After thorough gynecological examination, necessary investigations were made and written consent form was taken from them before laparoscopy. The patients were kept fasting for 24 hours before the laparoscopy and the procedure was performed under general anaesthesia. All the data was collected on pre-designed proforma and the results were tabulated and raw percentages calculated to describe the results. Results: Among 50 patients, 36 were of primary infertility cases and 14 were of secondary infertility. In primary infertility maximum number of patients belonged to age group of 21-25 years where as secondary infertility was under the age group 26–30 years and above 31 years of age. Longest duration of infertility in primary was 16 years and that in secondary was 17 years. Out of 50 patients, 7 (14%) had absolutely normal laparoscopic findings. Among the various pathologies observed, tubal pathology contributed the most (44%), followed by ovarian (30%), pelvic (18%) and uterine (16%) pathologies. Conclusions: Laparoscopy is safe and cost-effective method and should be considered as prime diagnostic tool for evaluating the etiology of infertility in women and for effective treatment decisions.
{"title":"Role of diagnostic laparoscopy in infertility","authors":"Abhishek Kumar, S. Snehlata, M. Srivastava, R. S. Vandana","doi":"10.17511/ijoso.2020.i01.02","DOIUrl":"https://doi.org/10.17511/ijoso.2020.i01.02","url":null,"abstract":"Background: Use of diagnostic and therapeutic laparoscopy in infertility has been a focus of attention in recent years and demonstrated to be very effective method in evaluating these cases. The main objective of the study was to detect the diagnostic efficacy of laparoscopy in uterine, pelvic and ovarian pathologies. \u0000Methods: This study was conducted from April 2017 to August2019.This prospective study included 50 infertile women and it was conducted at Vandana nursing home and IVF clinic. After thorough gynecological examination, necessary investigations were made and written consent form was taken from them before laparoscopy. The patients were kept fasting for 24 hours before the laparoscopy and the procedure was performed under general anaesthesia. All the data was collected on pre-designed proforma and the results were tabulated and raw percentages calculated to describe the results. \u0000Results: Among 50 patients, 36 were of primary infertility cases and 14 were of secondary infertility. In primary infertility maximum number of patients belonged to age group of 21-25 years where as secondary infertility was under the age group 26–30 years and above 31 years of age. Longest duration of infertility in primary was 16 years and that in secondary was 17 years. Out of 50 patients, 7 (14%) had absolutely normal laparoscopic findings. Among the various pathologies observed, tubal pathology contributed the most (44%), followed by ovarian (30%), pelvic (18%) and uterine (16%) pathologies. \u0000Conclusions: Laparoscopy is safe and cost-effective method and should be considered as prime diagnostic tool for evaluating the etiology of infertility in women and for effective treatment decisions.","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"77 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115039906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-16DOI: 10.17511/IJOSO.2020.I01.01
Dr. Laxmikanth Gurram, Dr. Padmanabh Inamdar, Dr. Manogyna D.
Background: Very few studies are available for the indication and the need of laparostomy in cases of faecal, biliary peritonitis and gangrenous bowel. The open abdomen procedure is one of the greatest surgical advances in recent times, avoiding the development of abdominal compartment syndrome. Methods: The present study was a prospective study of the patients who underwent laparostomy during 2yrs study period. Patients who met the inclusion criteria were included in the study. The indications, complications and outcomes of the study were noted. Results: Majority of the patients are in the age group of 31 to 40yrs. With laparostomy and damage control surgery recovery was seen in 86.6% patients. Post-operative complications were seen in 33.3% of the patients, with electrolyte imbalance, enterocutaneous fistula, anastomotic leak being the most common complications. Deaths were secondary to septicaemia with mortality rate 16.6%. Conclusion: Laparostomy or open abdomen is a useful emergency measure in certain conditions where there is a need for re-exploration for abdomen and cannot be closed due to gross edema and contamination. It reduces operative time and also facilitates re-look operations.
{"title":"Role of laparostomy in preventing early morbidity and mortality in advanced peritonitis patients","authors":"Dr. Laxmikanth Gurram, Dr. Padmanabh Inamdar, Dr. Manogyna D.","doi":"10.17511/IJOSO.2020.I01.01","DOIUrl":"https://doi.org/10.17511/IJOSO.2020.I01.01","url":null,"abstract":"Background: Very few studies are available for the indication and the need of laparostomy in cases of faecal, biliary peritonitis and gangrenous bowel. The open abdomen procedure is one of the greatest surgical advances in recent times, avoiding the development of abdominal compartment syndrome. \u0000Methods: The present study was a prospective study of the patients who underwent laparostomy during 2yrs study period. Patients who met the inclusion criteria were included in the study. The indications, complications and outcomes of the study were noted. \u0000Results: Majority of the patients are in the age group of 31 to 40yrs. With laparostomy and damage control surgery recovery was seen in 86.6% patients. Post-operative complications were seen in 33.3% of the patients, with electrolyte imbalance, enterocutaneous fistula, anastomotic leak being the most common complications. Deaths were secondary to septicaemia with mortality rate 16.6%. \u0000Conclusion: Laparostomy or open abdomen is a useful emergency measure in certain conditions where there is a need for re-exploration for abdomen and cannot be closed due to gross edema and contamination. It reduces operative time and also facilitates re-look operations.","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"44 12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114006748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-26DOI: 10.17511/IJOSO.2019.I05.07
N. N. Rao, C. Supradeeptha
Background: The Incidence of trauma related skeletal injuries have been on the rise in recent years and proximal humerus fractures are one of the most common fractures occurring in the human body. Hence the present study was conducted to evaluate the clinical and functional outcome of the proximal humeral internal locking system (PHILOS) technology.The present study was undertaken to assess the functional and radiological outcome of the proximal humeral internal locking system (PHILOS) for displaced proximal humeral fractures in adults. Method:The present prospective observational study was conducted in adults with proximal humerus fractures admitted to department of orthopedics, GSL Medical College and General hospital Rajahmundry during study period from 1st October 2015 to 31st March 2017. The study was approved by the institute’s ethical committee. Patients were undergo Open reduction internal fixation with philos locking plating for the sustained fracture under general anaesthesia. Post-operative physiotherapy followed according to protocol, to evaluate the functional outcome. Result: The average age of patients was 44 years. Males were 16 and females were 09. Most common mechanism of injury observed was Road traffic accident in 72%. The Constant- Murley score was significantly improved (p=.000) over the successive follow-up period. 01 (04%) patient had excellent Constant-Murley scores, 11 (44%) patients had good scores, as like 11 (44%) had moderate scores and only 2 (08%) patients had a poor functional outcome. Conclusion:In conclusion, the proximal humeral locking plate seems to be an adequate device for the fixation of displaced two-part, three-part and four-part proximal humerus fractures. Due to stable fixation, early functional aftercare is possible and allows the patient to regain good shoulder function and resume normal activities much earlier.
{"title":"Study on functional outcome of the proximal humeral internal locking system (PHILOS) for displaced proximal humeral fractures in adults","authors":"N. N. Rao, C. Supradeeptha","doi":"10.17511/IJOSO.2019.I05.07","DOIUrl":"https://doi.org/10.17511/IJOSO.2019.I05.07","url":null,"abstract":"Background: The Incidence of trauma related skeletal injuries have been on the rise in recent years and proximal humerus fractures are one of the most common fractures occurring in the human body. Hence the present study was conducted to evaluate the clinical and functional outcome of the proximal humeral internal locking system (PHILOS) technology.The present study was undertaken to assess the functional and radiological outcome of the proximal humeral internal locking system (PHILOS) for displaced proximal humeral fractures in adults. \u0000Method:The present prospective observational study was conducted in adults with proximal humerus fractures admitted to department of orthopedics, GSL Medical College and General hospital Rajahmundry during study period from 1st October 2015 to 31st March 2017. The study was approved by the institute’s ethical committee. Patients were undergo Open reduction internal fixation with philos locking plating for the sustained fracture under general anaesthesia. Post-operative physiotherapy followed according to protocol, to evaluate the functional outcome. \u0000Result: The average age of patients was 44 years. Males were 16 and females were 09. Most common mechanism of injury observed was Road traffic accident in 72%. The Constant- Murley score was significantly improved (p=.000) over the successive follow-up period. 01 (04%) patient had excellent Constant-Murley scores, 11 (44%) patients had good scores, as like 11 (44%) had moderate scores and only 2 (08%) patients had a poor functional outcome. \u0000Conclusion:In conclusion, the proximal humeral locking plate seems to be an adequate device for the fixation of displaced two-part, three-part and four-part proximal humerus fractures. Due to stable fixation, early functional aftercare is possible and allows the patient to regain good shoulder function and resume normal activities much earlier.","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131320494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-31DOI: 10.17511/ijoso.2019.i04.10
Jagdish B. Hedaoo, Vinod N. Rathod, Amit V. Paramne
Background: Surgical site infections (SSI) are one of the most common infections among the health care-associated infections. However, there is a scarcity of data on SSI from India. The present study was aimed to determine the incidences of SSI and to evaluate the associated factors at a hospital in Nagpur, central India region. Methods: Surgical sites were considered to be infected according to the set of clinical criteria recommended by the CDC’s NNIS system. The wounds were classified using the wound contamination class system, proposed by the American Centers for Disease Control (CDC) for use in SSI surveillance-1999, into Clean, Clean contaminated, Contaminated and Dirty wounds. Results: Among 2083 cases, 314 (15.1%) were suspected to be clinically infected, among them 250 (12%) were confirmed to have SSI. Among 2083 cases, 1214 (58.3%) operations included clean wound category and 869 cases (41.7%) were clean contaminated. From clean wounds 58 cases (4.8%) were found to be SSI and in clean contaminated wounds 192 (22.09%) cases were found to be SSI. Among the clean wounds, 103 (8.5%) were infected; about 58 cases (56.3%) were culture positive and 45 (43.7%) were culture negative. From the clean contaminated wounds, 211 (24.3%), 192 (91%) and 19 (9%) were found to be infected, culture positive and culture negative respectively. The studies of surgeries suggested that among clean surgeries Mastectomy was most common (14%), whereas Pyelolithotomy (8%) was the most common among the clean-contaminated surgeries. The prevalence of SSI was highest in Radical cystectomies (66.6%) and the least with lipoma excisions (6.4%). Conclusion: The incidences of SSIs in postsurgical infections were low in addition to this only small numbers of cases were confirmed to be SSIs. Though the reported cases are higher than the countries with high income, a well-planned strategy is required to decrease the incidences of SSI for improving the quality of health care system in present hospital and similar centers elsewhere.
{"title":"Incidence and patterns of surgical site infections in a teaching hospital in central India","authors":"Jagdish B. Hedaoo, Vinod N. Rathod, Amit V. Paramne","doi":"10.17511/ijoso.2019.i04.10","DOIUrl":"https://doi.org/10.17511/ijoso.2019.i04.10","url":null,"abstract":"Background: Surgical site infections (SSI) are one of the most common infections among the health care-associated infections. However, there is a scarcity of data on SSI from India. The present study was aimed to determine the incidences of SSI and to evaluate the associated factors at a hospital in Nagpur, central India region. \u0000Methods: Surgical sites were considered to be infected according to the set of clinical criteria recommended by the CDC’s NNIS system. The wounds were classified using the wound contamination class system, proposed by the American Centers for Disease Control (CDC) for use in SSI surveillance-1999, into Clean, Clean contaminated, Contaminated and Dirty wounds. \u0000Results: Among 2083 cases, 314 (15.1%) were suspected to be clinically infected, among them 250 (12%) were confirmed to have SSI. Among 2083 cases, 1214 (58.3%) operations included clean wound category and 869 cases (41.7%) were clean contaminated. From clean wounds 58 cases (4.8%) were found to be SSI and in clean contaminated wounds 192 (22.09%) cases were found to be SSI. Among the clean wounds, 103 (8.5%) were infected; about 58 cases (56.3%) were culture positive and 45 (43.7%) were culture negative. From the clean contaminated wounds, 211 (24.3%), 192 (91%) and 19 (9%) were found to be infected, culture positive and culture negative respectively. The studies of surgeries suggested that among clean surgeries Mastectomy was most common (14%), whereas Pyelolithotomy (8%) was the most common among the clean-contaminated surgeries. The prevalence of SSI was highest in Radical cystectomies (66.6%) and the least with lipoma excisions (6.4%). \u0000Conclusion: The incidences of SSIs in postsurgical infections were low in addition to this only small numbers of cases were confirmed to be SSIs. Though the reported cases are higher than the countries with high income, a well-planned strategy is required to decrease the incidences of SSI for improving the quality of health care system in present hospital and similar centers elsewhere.","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128764262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-31DOI: 10.17511/ijoso.2019.i04.09
Pragnesh A Patel, V. Gandhi
Background and Aim: Development of newer techniques and concepts of limb salvaging such as debridement, vascular reconstruction, soft tissue reconstruction and the use of microsurgical techniques has revolutionised the treatment of open fractures. Although, not all problems that confronted trauma surgeons in the past have been completely resolved; modern methods of open fracture management, skeletal fixation and soft tissue and bone reconstructions have dramatically improved the limb salvage. Materials and Methods: The present study was a prospective study of type III B open tibia fractures treated by skeletal stabilisation and soft tissue coverage in 60 patients. Soft tissue coverage was obtained by means of SSG in 16 patients, by fasciocutananeous flap in 26 patients and by muscle flap with SSG in 18 patients. Results: In this study sound bony union was obtained in 54 out of 60 cases with soft tissue coverage in 46 cases on primary basis and in 14 patients after secondary procedures. In cases with fasciocutaneous flap who had undergone external fixator had non-union. In the present study it was observed excellent results in 49 patients, good in 10 patients and poor in 1patient based on the scoring system in which parameters like soft tissue coverage, bone union/non-union. Conclusion: Timely meticulous wound management and early soft tissue cover leads to early sound bone healing and early restoration of the function of the limb. In type III open fractures internal fixation can be contemplated when presentation is early with minimal contamination; comminution and adequate soft tissue coverage can be obtained on acute basis.
{"title":"Management of soft tissue injury in the open tibia fractures","authors":"Pragnesh A Patel, V. Gandhi","doi":"10.17511/ijoso.2019.i04.09","DOIUrl":"https://doi.org/10.17511/ijoso.2019.i04.09","url":null,"abstract":"Background and Aim: Development of newer techniques and concepts of limb salvaging such as debridement, vascular reconstruction, soft tissue reconstruction and the use of microsurgical techniques has revolutionised the treatment of open fractures. Although, not all problems that confronted trauma surgeons in the past have been completely resolved; modern methods of open fracture management, skeletal fixation and soft tissue and bone reconstructions have dramatically improved the limb salvage. Materials and Methods: The present study was a prospective study of type III B open tibia fractures treated by skeletal stabilisation and soft tissue coverage in 60 patients. Soft tissue coverage was obtained by means of SSG in 16 patients, by fasciocutananeous flap in 26 patients and by muscle flap with SSG in 18 patients. Results: In this study sound bony union was obtained in 54 out of 60 cases with soft tissue coverage in 46 cases on primary basis and in 14 patients after secondary procedures. In cases with fasciocutaneous flap who had undergone external fixator had non-union. In the present study it was observed excellent results in 49 patients, good in 10 patients and poor in 1patient based on the scoring system in which parameters like soft tissue coverage, bone union/non-union. Conclusion: Timely meticulous wound management and early soft tissue cover leads to early sound bone healing and early restoration of the function of the limb. In type III open fractures internal fixation can be contemplated when presentation is early with minimal contamination; comminution and adequate soft tissue coverage can be obtained on acute basis.","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128118179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-31DOI: 10.17511/ijoso.2019.i04.05
V. Malviya, Ramkumar Soni
Background: Stenosing tenosynovitis or trigger finger frequently involves the thumb and ring fingers of the dominant hand and more commonly seen in adult female population, in their 5th and 6th decades of life. Method: In this study, 18-gauge needle was used for the percutaneous release of trigger finger without any local anaesthesia in 12 patients with prior consent. Results: Highest numbers of patients were in 41-60 years age group (66.7%). 3 patients (25%) belong to 20-41 years age group. Only 1 patient (8.3%) of age group 61-80 was affected by trigger finger. 7 Patients (58.3%) were females and 5 patients (41.6%) were males. The most commonly affected finger was the ring (58.3%) followed by the middle (33.3%) and index (8.3%). Right hand and left hand was affected side in 8 (66.6%) and 4 (33.3%) patients respectively. According to greens classification, Grade II patients were 50%, grade III 41.6% and grade IV 8.3%. Average duration of the procedure was 5-7 minutes. There was no evidence of complications. 4 patients experienced mild postoperative pain. In one patient the procedure has to be abandoned as patient could not tolerate the pain. Conclusion: As we do not use local anaesthesia localization of A 1 pulley in trigger finger is much easier for percutaneous release. Therefore, the procedure is more effective and time saving as well. ………………………………………………………………………………………………………………………………...
{"title":"Percutaneous release of trigger finger without local anaesthesia as an outpatient procedure","authors":"V. Malviya, Ramkumar Soni","doi":"10.17511/ijoso.2019.i04.05","DOIUrl":"https://doi.org/10.17511/ijoso.2019.i04.05","url":null,"abstract":"Background: Stenosing tenosynovitis or trigger finger frequently involves the thumb and ring fingers of the dominant hand and more commonly seen in adult female population, in their 5th and 6th decades of life. Method: In this study, 18-gauge needle was used for the percutaneous release of trigger finger without any local anaesthesia in 12 patients with prior consent. Results: Highest numbers of patients were in 41-60 years age group (66.7%). 3 patients (25%) belong to 20-41 years age group. Only 1 patient (8.3%) of age group 61-80 was affected by trigger finger. 7 Patients (58.3%) were females and 5 patients (41.6%) were males. The most commonly affected finger was the ring (58.3%) followed by the middle (33.3%) and index (8.3%). Right hand and left hand was affected side in 8 (66.6%) and 4 (33.3%) patients respectively. According to greens classification, Grade II patients were 50%, grade III 41.6% and grade IV 8.3%. Average duration of the procedure was 5-7 minutes. There was no evidence of complications. 4 patients experienced mild postoperative pain. In one patient the procedure has to be abandoned as patient could not tolerate the pain. Conclusion: As we do not use local anaesthesia localization of A 1 pulley in trigger finger is much easier for percutaneous release. Therefore, the procedure is more effective and time saving as well. ………………………………………………………………………………………………………………………………...","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128825218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-31DOI: 10.17511/ijoso.2019.i04.11
M. Kumar, Mozammil Pheroz, V. Gupta, V. K. Pandey, A. Jain, V. Sharma
Background: Nutritional rickets is one of the most common metabolic disease of bone. The purpose of this study is to evaluate the level of Vitamin-D in children with rickets and establish that rickets in India is due to Vitamin-D deficiency and to compare and analysed the preand post –treatment radiographic parameters in nutritional rickets being treated by Stoss therapy. Interventional study, done at Central Institute of Orthopaedics, Safdarjung Hospital, New Delhi, India between October 2015 and May 2017. Material and Methods: A total of 44 patients in the age group of 6 months to 16 years with signs of active rickets participated in the study. All the participants received Stoss therapy (mega dose of vitamin D) and the response to treatment was observed and recorded at regular follow up with clinical, biochemical and radiological parameters. Thacher’s score was used for radiological evaluation. Results: After starting treatment, 4 subjects out of 44 had zero score at 3 weeks. whereas at 6 weeks, 3 month 10 subjects and 17 subjects had score zero respectively. At 6 month all subject had score zero. Conclusion: The Stoss therapy is very effective and safe regimen for the treatment of rickets. The 10 points Thacher’s scoring method for assessing the severity of rickets shows promise as a useful tool for researchers and clinicians.
{"title":"Radiological resolution of nutritional rickets with mega dose of vitamin D - “Stoss Therapy”: a hospital-based study","authors":"M. Kumar, Mozammil Pheroz, V. Gupta, V. K. Pandey, A. Jain, V. Sharma","doi":"10.17511/ijoso.2019.i04.11","DOIUrl":"https://doi.org/10.17511/ijoso.2019.i04.11","url":null,"abstract":"Background: Nutritional rickets is one of the most common metabolic disease of bone. The purpose of this study is to evaluate the level of Vitamin-D in children with rickets and establish that rickets in India is due to Vitamin-D deficiency and to compare and analysed the preand post –treatment radiographic parameters in nutritional rickets being treated by Stoss therapy. Interventional study, done at Central Institute of Orthopaedics, Safdarjung Hospital, New Delhi, India between October 2015 and May 2017. Material and Methods: A total of 44 patients in the age group of 6 months to 16 years with signs of active rickets participated in the study. All the participants received Stoss therapy (mega dose of vitamin D) and the response to treatment was observed and recorded at regular follow up with clinical, biochemical and radiological parameters. Thacher’s score was used for radiological evaluation. Results: After starting treatment, 4 subjects out of 44 had zero score at 3 weeks. whereas at 6 weeks, 3 month 10 subjects and 17 subjects had score zero respectively. At 6 month all subject had score zero. Conclusion: The Stoss therapy is very effective and safe regimen for the treatment of rickets. The 10 points Thacher’s scoring method for assessing the severity of rickets shows promise as a useful tool for researchers and clinicians.","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124159882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-31DOI: 10.17511/ijoso.2019.i04.02
R. Soni, V. Malviya
Background: Dupuytren’s disease is common benign proliferative disorder of the palmer fascia and is a part of a group of fibromatosis that includes planter fibromatosis (Ledderhose disease) and penile fibromatosis (Peyronie’s disease). It tends to present in sixth and seventh decade of life but can present earlier or later. Method: we recruited eleven patients with Dupuytren’s contracture of hand in the present study. Percutaneous release of the Dupuytren’s band was performed under local anesthetic agent with an 18 Gauze needle in outpatient department. Postoperatively all patients underwent the programme of extended vigorous physical therapy of the hand and series of triamcinolone injections at 4 monthly interval for 1 year. Result: In our study all patients were males in the age range of 48 to 78 years. Commonly involved finger was the ring finger in six patients followed by little finger in three and middle finger in two. Nine patients had right finger affected and in rest two left side fingers were affected. All patients did well and there was no recurrence of contracture in any patients during the study period. One patient experienced unexplained chronic pain in the finger. Postoperatively range of motion improved significantly after 18 months of follow-up. Conclusion: Percutaneous needle aponeurotomy with extended post-operative physical therapy and serial 4 monthly intralesional steroid injections in Dupuytren’s contracture is reliable and relatively simple to perform compared to partial aponeurectomy. This regime of treatment could be seen as a serious alternative for selected cases.
{"title":"Needle aponeurotomy for dupuytren’s contracture of hand with extended physical therapy and serial intralesional steroid injections","authors":"R. Soni, V. Malviya","doi":"10.17511/ijoso.2019.i04.02","DOIUrl":"https://doi.org/10.17511/ijoso.2019.i04.02","url":null,"abstract":"Background: Dupuytren’s disease is common benign proliferative disorder of the palmer fascia and is a part of a group of fibromatosis that includes planter fibromatosis (Ledderhose disease) and penile fibromatosis (Peyronie’s disease). It tends to present in sixth and seventh decade of life but can present earlier or later. Method: we recruited eleven patients with Dupuytren’s contracture of hand in the present study. Percutaneous release of the Dupuytren’s band was performed under local anesthetic agent with an 18 Gauze needle in outpatient department. Postoperatively all patients underwent the programme of extended vigorous physical therapy of the hand and series of triamcinolone injections at 4 monthly interval for 1 year. Result: In our study all patients were males in the age range of 48 to 78 years. Commonly involved finger was the ring finger in six patients followed by little finger in three and middle finger in two. Nine patients had right finger affected and in rest two left side fingers were affected. All patients did well and there was no recurrence of contracture in any patients during the study period. One patient experienced unexplained chronic pain in the finger. Postoperatively range of motion improved significantly after 18 months of follow-up. Conclusion: Percutaneous needle aponeurotomy with extended post-operative physical therapy and serial 4 monthly intralesional steroid injections in Dupuytren’s contracture is reliable and relatively simple to perform compared to partial aponeurectomy. This regime of treatment could be seen as a serious alternative for selected cases.","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124687521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-31DOI: 10.17511/ijoso.2019.i04.07
D. Chaurasia, Nirnay Pandey
Background: Fracture and dislocation of hand most frequently encounter in orthopaedics injuries fracture of phalanges and metacarpal are approximately 10% of all fracture of skeleton system phalangeal fracture comprise 46% of hand fractures, metacarpal fractures 38% and fifth metacarpal fracture 9.7%, distal phalangeal fractures are most commonly encounter fracture of the hand. The annual incidence of phalangeal fracture in hand is 1% in normal population. And these injuries account for between. 2% and 3% of all patient visiting in accident and emergency unit thumb and middle finger are most frequently injured because they extend most distally during work activity. Aim & Objectives: To evaluate the structural and functional outcomes and the results of operative and conservative management of metacarpal and phalangeal fractures of hand. Methods: The present study comprises of 62 patients of closed fractures of metacarpal and phalanx treated in the Department of Orthopaedic Surgery, Shyam Shah Medical College and associated Sanjay Gandhi Memorial Hospital Rewa (M.P.) in a span of two years. Evaluation of outcomes after management of metacarpal and phalangeal fractures of hand was done. Results: We achieved 24 (85.7%) excellent and good results in conservative method for metacarpal fractures and 10 (83.33%) operative methods. In Phalangeal fractures 09 (90.0%) excellent and good results were achieved in conservative method and 10 (83.34%) in operative methods. Excellent and good grip strength was noted in 53 (85.33%) cases. Single digit involvement had better TAM then multiple digits involvement. Poor results were noted in metacarpal fractures in 04 (14%) in conservative series and 02 (16.0%) in operative series. Poor results were seen in phalangeal fractures in 01 (10%) in conservative series and 02 (16.66%) in operative series. Most common complication was finger stiffness in conservative method and pin site infection in operative methods. Conclusion: Both conservative and operative methods (surgical stabilization) for metacarpal and phalangeal fractures of hand gave good functional outcomes, depending on the fracture pattern for treatment option, single digit involvement are important determinants to achieve a better grade of total active range of motion.
{"title":"Evaluation of outcomes after management of metacarpal and phalangeal fractures of hand","authors":"D. Chaurasia, Nirnay Pandey","doi":"10.17511/ijoso.2019.i04.07","DOIUrl":"https://doi.org/10.17511/ijoso.2019.i04.07","url":null,"abstract":"Background: Fracture and dislocation of hand most frequently encounter in orthopaedics injuries fracture of phalanges and metacarpal are approximately 10% of all fracture of skeleton system phalangeal fracture comprise 46% of hand fractures, metacarpal fractures 38% and fifth metacarpal fracture 9.7%, distal phalangeal fractures are most commonly encounter fracture of the hand. The annual incidence of phalangeal fracture in hand is 1% in normal population. And these injuries account for between. 2% and 3% of all patient visiting in accident and emergency unit thumb and middle finger are most frequently injured because they extend most distally during work activity. Aim & Objectives: To evaluate the structural and functional outcomes and the results of operative and conservative management of metacarpal and phalangeal fractures of hand. Methods: The present study comprises of 62 patients of closed fractures of metacarpal and phalanx treated in the Department of Orthopaedic Surgery, Shyam Shah Medical College and associated Sanjay Gandhi Memorial Hospital Rewa (M.P.) in a span of two years. Evaluation of outcomes after management of metacarpal and phalangeal fractures of hand was done. Results: We achieved 24 (85.7%) excellent and good results in conservative method for metacarpal fractures and 10 (83.33%) operative methods. In Phalangeal fractures 09 (90.0%) excellent and good results were achieved in conservative method and 10 (83.34%) in operative methods. Excellent and good grip strength was noted in 53 (85.33%) cases. Single digit involvement had better TAM then multiple digits involvement. Poor results were noted in metacarpal fractures in 04 (14%) in conservative series and 02 (16.0%) in operative series. Poor results were seen in phalangeal fractures in 01 (10%) in conservative series and 02 (16.66%) in operative series. Most common complication was finger stiffness in conservative method and pin site infection in operative methods. Conclusion: Both conservative and operative methods (surgical stabilization) for metacarpal and phalangeal fractures of hand gave good functional outcomes, depending on the fracture pattern for treatment option, single digit involvement are important determinants to achieve a better grade of total active range of motion.","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129000464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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